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Electronic Transaction Toolkits for Administrative Simplification

The AMA is committed to reducing administrative burdens on practices. Physicians and practice staff spend hours dealing with complex issues surrounding the insurance claim payment process, including prior authorizations, patient eligibility inquiries, claim filing and payment reconciliation, costing the practice money and time that could be better spent on patient care.

Physicians and their staff can reduce the time spent on these burdensome processes by implementing standard electronic health care transactions to complete practice revenue functions. The AMA’s electronic transaction toolkits offer a wealth of information to help practices transition to electronic processes and improve the efficiency of their business.

Electronic Transaction Guidance

The following AMA-developed resources provide an overview of the standard electronic transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA), offer implementation guidance and detail actions practices can take if they encounter health plan compliance issues.

Electronic Payment Toolkits

In recent years, health plans have shifted from paper checks to electronic methods of physician payment. Health plans are required to offer electronic funds transfer (EFT) payments using the Automated Clearing House (ACH) Network to practices that request this method of claims payment.

Additionally, many health plans have started paying physicians through virtual credit cards (VCCs), which are processed using standard credit card technology but can result in significant lost revenue for practices. The following resources provide information and guidance to physicians on electronic payments.

Electronic Claims Toolkit

The AMA, in collaboration with the Medical Group Management Association, developed the Electronic Claims Toolkit (PDF) to help physicians and practice staff understand the electronic claim submission process and maximize the benefits and efficiencies of an automated process.

LinkedIn Group

The AMA Administrative Simplification LinkedIn Group is designed to provide updates and encourage dialogue on administrative issues affecting physician practices, including automation using electronic standards and operating rules, prior authorization standardization and reform, and regulatory developments. Physicians, practice staff and other interested stakeholders are encouraged to join.